Special Populations Flashcards
BILATERAL AMPUTATIONS
BILATERAL AMPUTATIONS
- Simultaneous bilateral limb loss is __________.
- What is the major cause of bilateral lower limb loss?
- infrequent
- dysvascular disease (usually effects both limbs, rehab is heavily impacted)
What is an important thing to consider for patients progressing from unilateral to bilateral amputation as far as success goes?
Successful unilateral prosthetic use undicator of bilateral success.
AS compared to unilateral amputations, bilateral concepts remain the same.
- _____ fitting
- Avoiding complications
- Preservation of the _____ joint is critical.
- early
- knee
Bilateral amputee progression is significantly ______ and we see an _______ in energy expenditure.
- slower
- increase
- Bilateral amputees have an increased fear of falling, what are some reasons for this?
- How do we address this?
- BOS reduced, decreased proprioception
- lack of anterior support
- emphasis on transfers and trunk control
- teach how to fall and recover
Is a bilateral transtibial or unilateral transfemoral amputee more energy effecient?
bilateral transtibial
Bilateral Transtibial Components:
- Tend to have _____ foot/ankle on each limb.
- Absorb ______.
- Protect the limb.
- Suspension (decrease _______, _____/_____ preferred)
- same
- shock
- decrease pistoning, vacuum/suction preferred
What are some rehab considerations for bilateral transtibial amputees?
- Gait
- Balance
- Falling
- W/C and AD use
- UE strength
- Progress as normal….
Bilateral Transfemoral Components:
- Reliable ______/______ phase control from the knee unit.
- Stability from the _____/_____.
- _______ containment socket.
- ________ suspension with appropriate liner.
- “_________”
- stance/swing
- ankle/foot
- ischial
- suction
- “Stubbies”
When can “Stubbies” be useful?
Early in progression of a transfemoral amputee.
What are some rehab considerations for bilateral transfemoral amputees?
- Balance
- Transfers
- W/C skills
- Falling/recovery
- UE strength
- Gait
- Transfemoral and transtibial amputees tends to have a _______ prognosis than bilateral transfemoral amputees.
- The emphasis should be on the _______ side (strength and prosthetic components) and should involve optimization of the __________ side when possible.
-better
- transtibial
- transfemoral
What gait characteristics do we expect with bilateral amputees?
- Wide BOS with decreased speed
- Typically use AD
- Very taxing
- Community barriers
Bilateral LE Main Takeaways:
- Gait with bilateral prostheses _______ energy expendture.
- Even if ambulatory ALL B LE amputees need to have profecient / skills.
- Although slower, general progression is still ________
- Increased likelihood of _____ deviations.
- increases
- W/C
- the same
- gait
PEDIATRIC AMPUTEES
PEDIATRIC AMPUTEES
What are the different challenges that pediatric amputees face that are different than adult amputees?
- Motor development and milestones
- Learning
- Psychosocial
- Skeletal
- Neuromuscular
- The basic components of pediatric prosthetics are the _____ but ________.
- They require ______ durability, and thus have _____ choice.
- same but smaller
- more durability, less choice
With pediatric amputees, we need to accomodate growth and use.
- Grade School = __-__ months
- Teenagers = __-__ months
- Heavy day to day use and vigorous play
- Socket fit
- Grade School = 12-18 months
- Teenagers = 18-24 months
A lot of time a prosthetist will build a much bigger socket than needed for a child, why?
To allow for removal of socks/liner instead of having to get a new socket while growing.
What is a rotationplasty?
Knee joint is removed, lower leg is turned and attached to femur; ankle now functions as a knee.
When is a rotationplasty used?
Used for tumors of the distal femur or proximal tibia, typically in peds.
A rotationplasty prosthetic is similar to a __ prosthesis. There is no phantom limb and they have a ______ return to function.
- TT
- quick
With a rotationplasty:
- PF = knee ________
- Df = knee _________
- extension
- flexion
Pediatric Main Takeaways:
- Rehab _____>________ and ____ use.
- Educate parents on ________, device __________, and ________/________.
- Make therapy age appropriate.
- Encourage use.
- Encourage adaptive sports.
- Be realistic.
- ROM>strength, AD use
- skin care, device function, donning/doffing
HIGH-LEVEL AMPUTEE REHAB
HIGH-LEVEL AMPUTEE REHAB
What is the goal for high-level amputee rehab?
- Allow for participation in physical exercise and/or sports.
- Want to maintain or enhance physical conditioning gained during functional rehab.
What are the responsibilites of the rehab team with high-level amputee rehab?
- injury prevention
- motivation
- education
What are some things to have before progressing to high-level rehab?
- Acceptable gait (walking and running)
- Stable volume
- Skin condition
- Baseline health
- Reason for amputation
What is the ideal team when working with our patient?
- Patient
- Coach
- Prosthetist
- Strength and Conditioning Coach
- PT
What is the role of the prosthetist?
- Designs prosthetic that is relevant to the increased demand of the amputee athlete.
- Modifies componentry to maximize function and reduce injury risk.
- Frequent communication.
What is the role of the coach?
- Must understand muscle function, imbalance, and injury risk concepts.
- Produce a tailored and individualized program.
- Careful monitoring.
- Frequent communication.
What is the role of the strength and conditioning specialist?
- Develops optimal conditioning for the specific sport or activity.
- Target all aspects of strength, power, stability, endurance, balance, and CV fitness.
- Monitoring.
- Frequent communication.
What is the role of the PT?
Basic assessment - determine readiness (seek medical clearance as necessary).
What are the parts of the readiness assessment?
- Gait, CV fitness, core strength, balance, proprioception, muscle imbalances.
- History of previous participation.
- History of previous injury,
- Frequent communication.
What PT interventions are important when going to high-level?
Basic strength and conditioning -UE/LE -Injury prevention -Coordination with CSCS Core stability -improved power output -provide for a stable base -sport specific Gait training -identify deviations -to correct or not? -running assessment
Muscle Strength and Imbalances (TTA):
- Intact limb is stronger than amputated leg (less difference in amputee _________)
- Hip musculature can be ___________ (increased energy absorption and generation at the hip, also compensates for lack of PF)
- Eccentric ______ power is increased in sound limb, but eccentric _______ power was greater in amputated leg.
- athlete
- overactive
- HS, quad
As far as cardiovascular impact goes, amputees have a lower _____ max and __________ thresholds than able bodied individuals.
- VO2
- anaerobic
Amputees already have non-optimal biomechanics. What may happen if we ask them to perform some kind of mechanical overload?
- compensatory mechanisms
- over-reliance on sound limb
What are some compensatory mechanisms we may see?
- Asymmetrical overload of sound limb during gait
- Knee total work less on amputated side vs intact (TTA)
- Increased hip energy generation on amputated side
- All increased if the RL is painful!
How do we reduce the risk as far as overload goes?
High energy demand + less muscle to generate force = INCREASED RECOVERY TIME
Strengthening:
- Address ___________ movements through rehabilitation efforts first.
- Strengthening should be ____________ (core strength and stability)
- Principles of strengthening same for able bodied individuals (w exception of increased recovery time).
- Increase load appropriately.
- compensatory
- sport specific
Endurance:
- Can take on a variety of forms.
- ______ specific.
- Principles the same for able bodied individuals.
- Consider that the amputated limb may _______ faster than the sound limb or the CV system.
- sport
- fatigue
- What are common gaits to see in prosthetic running?
- What amputations is it even more common in?
- circumduction and vaulting
- TFA and bilateral
Why are circumduction and vaulting common?
- Length of the prosthetic.
- Difficulty maintaining posture due to limb length differences.
What are the 4 steps of prosthetic running?
- ) Trust the prosthesis
- ) Hip extension
- ) Stride symmetry
- ) Arm carriage
Prosthetic Sprinting- An Advantage?
- _______ symmetry during start
- __________ phase requires continuous adaptation by the runner.
- > 200m = ______
- Bilateral implications
- decreased
- acceleration
- turns
Prosthetic vs able-bodied sprinters disadvantages?
- Increased demand in muscle work
- Asymmetrical stride length, stride time, and impact loads
- More energy expenditure (debatable)
- Increased mechanical work on sound limb
- Change in mechanics
- ~10% reduction in force
Prosthetic cycling advantages?
- can be started earlier than running
- may not require specialized prosthesis
- low impact
- can allow for balance loss
Prosthetic cycling common modifications?
- pedal systems
- shortened, wider crank arm
- recumbent bikes
Amputee Athletes Main Takeaways:
- ____ effort.
- Risk of ________, there must be a balance to avoid considerable setback.
- Needs to be finished with “_______” rehab before progressing, have a mature limb.
- Running blades ______ increase performance.
- Unlimited options for athletic involvement.
- team
- overload
- “normal”
- do not
